=~ 5 Sin Prevention of fatigue may be attained by! (a) Health examination and advice (c) Proper rest (b) Regular exercise (ad) Balanced diet Deficiencies of Play With the increased complexities and tensions of life, a properly balanced program of play has become a health necessity, not a luxury. Deficiency of Play The deficiency of play in childhood interferes definitely with the normal development of the minds and personality. In adult life, a lack of time and ability to play may lead to serious nervous and sometimes mental disorders. Habits of play are of equal importance with habits of eating and sleeping. Deficiencies and Excesses of Rest The normal human being can stand considerable of the stresses and strains of mocsrn life if he has learned the art of resting. This rest may take the form of change or actual sleep. The results of deficient rest express themselves in every organ and system in the body. Inadequate rest may disturb the digestion, cause loss of weignt, mental irritability, and lay the foundation for actual organic disease. No defensive hygiene projram could possibly protect the health which did not include sufficient rest both in quantity and quality. . References: Storey----Defensive Hygiene, chaps. 7-15 Williams--Personal Hygiene Applied, chaps. 6-11 Meredith--Hygiene, chaps. 27-31, 33, 35, 42. DISCUSSION QUESTIONS : 1. Outline a personal hygiene program which would automatically take care of the excesses and deficiencies of modern life. 2. Describe how you would determine for yourself whether your program of excretion was deficient or excessive. 5. What guides would you use in judging whether your program of rest was adequate? 4. How would you safeguard yourself against excessive exercise in compcti-~ tion? * Aa eeagerenncne es at Stanford University School of tygiene and Physical Ecucation INFORMATIONAL HYGIENE REFERENCE LIST FOR INFORMATIONAL HYGIENE COURSES 150, 151, 152, 153 and 154. Note: The following references will usually be found in the Reserve Room of the University Library unless otherwise indicated. Keferences marked thus (*) are to be found in the stacks. Keferences marked thus (#) are to be found in the Document Room. aA few references will be reserved only at the time certain courses are offered. If not found on reserve, consult catalog. The plan of this classification follows in general the outlines of the courses in the order given above. ViTsai STaTiSTics Dublin, L. I., Health and Wealth Fisher, I., Report on National Vitality Kirkpatrick « Huettner, Fundamentals of Health Moore, H. H., Public Health in the United States Pearl, R., Alcohol and Longevity Rosenau, M. J., Preventive Medicine and Hygiene Whipple, G. C., Vital Statistics (liethod) # U. S. Census Bureau, Annual Mortality Statistics # U. S. Public Health Service, Public ..calth Reports (Annual summaries) tes GENETICS aND EUGENICS Bossard, J. H. S., Problems of Social Well-being Carr—Saunders, A. Mi., Eugenics Conklin, E. G., Heredity and Environment Cowdry, EB. V., Human Biology and Facial welfare Gosney « Popenoe, Sterilization for Human Betterment Guyer, Mi. F., Being Well—born Jennings, H. S., Biological Basis of Human Nature Popenoe, P., The Child's Heredity Popenoe « Johnson, spplied Eugenics Stockard, ©. R., Physical Basis of Personality Storey, T. 4., Principles of Hygicne Walter, H. E., Genetics CELL STRUCTURE sAND aNeTOMy Kirkpatrick & Huettner, Fundamentels of Health hicMurrich, J. P., Levelopment of Human body Storey, T. A., Principles of Hygiene * Wilson, E. B., The Cell in vVevelopment and Heredity (3d Ed.) ie GENERAL PHYSIOLOGY Burton—-Opitz, Textbook of Physiology Cannon, W. i., sodily Changes in iiunger, Fear & c Cannon, W. Be, The Wiscom of the Body Hough « Sedgwick, The humen liechanism Howell, ». iif, Textbook of Physiology Kirkpatrick « Huettner, fundamentals of Health Michiurrich, J. P., Levelopment of iiuman Body Martin, H. N. « E. G., Human body liartin « Weymouth, Elements of Physiology (In Biology Library) Meredith, Ff. L., Hygiene MacLeod, J. J. Re, Physiology and biochemistry in Medicine Parsons, T. &., The Materials of Life Parsons, T. S., Fundamentals of biochemistry Storey, T. A., Principles of Hygiene NUTRITIGN saND FOODS Bogert, L. J., Nutrition and Physicai Fitness Bradley, a. V., Tubles of Food Values Callow, A. B., Food and health Eddy, Ww. H., Nutrition Emerson, Wi. R. P., Diagnosis of Health Frie denweld « Fuhran, Diet in Health and Disease Gillett, L. H., Food for Health's Sake Locke, E. A., Food Values licCollum & Simmonds, Food, Nutrition end Health McColium & Simmonds, Newer Knowledge of Nutrition Rose, M. S., Feeding the Family Rose, M. S., Foundations of Nutrition Sansum, W. D., The Normal Diet Sherman, H. C., Chemistry of Food ana Nutrition Sherman end Smith, The Vit mins Stiles, P. G., Nutritional Physiology Storey, T. a., Principles of Hygicne EXERCISE sND MUSCLE PHYSIOLOGY Bainbridge, F. 4., Physiology of iuscular Exercise Fulton, J. F., Musculer Contraction Gould and Dye, Exercise and Its Physiology Hili, A. V., Musculer Activity licCurdy « McKenzie, Physiology of Exercise McKenzie, k. T., Exercise in Education und Medicine # U. S. Public Health Service, Reprint No. 465, Present Status of Our Knowledge or Fatigue Products Storey, T. A., Principles of Hygiene mom ok 4, 1s REST Laird & Muller, Sleep Storey, T. A., Principles of Hygiene NERVOUS SYSTEM AND MENTAL HYGIENE Adler, 4a., Understanding Human Nature Burnham, W. H., The Normal Mind Burnham, Wi. H., Wholesome Personulity * Burnham, W. h., Great Teachers and ental Health Calverton & Schmaihausen, Sex in Civilization Cannon, W. B., Bodily Changes in Fear, Hunger & c Dodge ena Kahn, The Craving for Superiority Dorsey, G. A., Why We Behave Like Human Beings Fishbein & White, Why Men Fail Groves, E. R., Fersonality « Social Adjustment Groves snd Blanchard, Introduction to Mental Hygiene Gulick, L. H., & Philosophy of Play Kitson, H. b., How to Use Your Mind Lee, J., Pliy in Education McDougall, W., Character and Conduct of Life Meninger, K., The Human Mind Meredith, F. L., Hygiene O'Shea, il. V., The Child: His Nature and His Needs O'Shea, Mi. V., Tobacco and Mental Efficiency Overstreet, H. A., About Ourselves Pratt, G. K., Your Mind and You Thom, D. A., Normal Youth and Its Everyday Problems # U. S. Public Health Service, Bulletin No. 148, Mental Hygiene White, W. A., Mental Hygiene of Childhood White, W. A., Principles of Mental Hygiene Williems, ¥. E., Adolescence * Zachary, C. B., Personality and Adjustment of School Children MEDICINE, GENERaAL aND HiSTOKICaL american Medical Association, Hygeinu (Monthly, in Periodical Room) Davis, li. ll., Clinics, Hospitals end Health Centers DeKruif, P., iiicrobe Hunters DeKruif, P., Men Against De:th Fishbein, M., Medical Follies Fishbein, M., The New Medical Follies Macfie, RK. C., Romance of Medicine Moore, li. H., americen Medicine « The People's Health af. Newsholme, ., Evolution of Preventive liedicine Newsholme, A., Story of Modern Preventive Medicine Ravenel, M. P., Half Century of Public Health Vallery-Redot, F., Life of Pasteur Vedder, E. B., Medicine: Its Contribution to Civilization DISEASE AND BaCTERIOLOGY Barker & Sprunt, The Degenerative Diseases Broadhurst, J., How We Resist Disease Chandler, A. C., Animal Parusites anu Human Disease Chapin, C. V., Sources and liodes of infection Cecil, R. L., Colds: Cause, Treatment « Prevention DeKruif, P., Microbe Hunters Hamilton, A. E., This Smoking Worid # Love & Davenport, Defects Found in Drafted Men (War Department?) McLaughlin, A. J., Communicable Diseases Park « Williams, Who's Who Among the Microbes Rice, T. B., Conquest of Visease Rosenau, M. J., Preventive Medicine « Hygiene Steel and White, Hygiene of Community, School and Home Storey, T. 4., Principles of Hygiene * Terry and Pellens, The Opium Problem * Vaughun, V. C., Epidemiology and the Public Health ahs PERSONAL HYGIENE, GENERAL Emerson, W. KR. P., Diagnosis of Health Fisher & Fiske, How to Live Fiske, E. L., Health Building and Life Extension Groves, E. R., Personslity « Social Adjustment Hoffmann, R. H., The Struggle for Health Kirkpatrick & Huettner, Fundamentals of Health Luckiesh & Pacini, Light end Health Meredith, F. L., Hygiene O'Shea, M. V., Tobacco and Mental Efficiency von Gruber, M., Hygiene of Sex Williams, J. F., Personal Hygiene Applied SOCIAL PROBLEMS, GENERAL Bossard, J. H. S., Problems of Social fiell-being Bogardus, E. S., Introduction to Sociology Binder, RK. M., Health and Social Progress Blackmar & Gillin, Outlines of Sociology Calverton « Schmalhausen, Sex in Civilization Cowdry, E. V., Human Biology and Racial Welfare Dublin, L. I., Health and Wealth Fairchild, H. P., Foundations of Social Life Huntington, E., Civilization end Climate Huntington & Whitney, Builders of America March, N. H., Towards Racial Health Rice, T. B., Racial Hygiene *% x * % * -8- PROBLEMS OF HOM AND Puli LY Ebel, hi. W., Successful Family Life on the Moderate Income éAmericen Chila Health Association, Influence of Socic-Economic Factors on Health Beldersstons, L. h., Housewirery Brondhurst, J., Home and Comunity Hygiene Culverton « Schmulhausen, Sex in Civilization Child Study Association of -smerica, Concerning Parenthood Gulloway, T., Love and Marriage Goodsell, W., Problems of the Family Groves « GUgburn, Americen Marriage and Family Kelationships Groves, i. K., The Marriage Crisis Groves, E. R., Wholesome Murriage Groves, E. k., Social Problems of the Family Groves, E. R., The brifting Home Povenoe, P., Conserwuition oi the Family Popenoe, P., iodern Marriage Reports of Heller Committee for Social Research, University of California Reuter & Runner, The Fimily hich, M. E., Family Life Today Richardson, F., Parenthood and the Newer Psychology Rose, M. S., Feeding the Family Spencer, A., The Family and Its Members Steel &« White, Hygiene of Community, School « Home Tuber, C. W., Tie Business of the Household White House Conference on Child Hostth & Protection (Full Series - See Catt.log) Wile « Winn, Marriege in the Modern iicnner CHILD CakE American Child Health association, Public Health aspects of Dental Decuy American Child Health Association, influence of Socio-Economic Factors on Health Baker, J., Child Hygiene Keene, C. H., Physical Welfare of the School Child Lucas, WW. P., Health of the Runebout Child O'Shea, M. V., The Child: His Nature and His Needs Terman « Almack, Hygiene of the School Child White House Conference on Child Health & Protection (Full Series - See catalog) r £5 nee AT ee ca SCHOOL HYGIENE * Americun Child Health Association, Health Education Tests Keene, ©. H., Physical Nelfare of the School Child Kerr, J., fundamentals of School Health Newmuyer, 5S. W., Medical end Sanitary Inspection of Schools Rosenau, M. J., Preventive Medicine & Hygiene Steel « White, Hygiene of Community, School & Home Terman « Almack, Hygiene of the School Child * White House Conference on Child Health & Protection (Full Series - See Catalog) Wood « howell, Health Supervision & Medical Inspection in Schools atl, ae INDUSTRIAL HYGIENE Clerk, J. H., Lighting in kelation to Public Health Clerk, WV, I., Health Service in Industry Kober «x Hayhurst, Industrial Heslth Roseneu, M. J., Preventive Medicine ...4 Hygiene ae COMMUNITY HYGIENE (PUBLIC HEALTH) American Child Health Association, Heulth Survey of 86 Cities Anericen Public keelth association, Appraisal Form for City Health Work American Public Health association, appraisal Form for Rural Health Work Briinurd, As Me, Organization of Public Health Nursing Chapin, C. V., Sources and ilodes of Infection Clark, J. H., Lighting in kelation to Public Health Commonwealth Fund, Community Heelth Orgcnization iemenway, H. E., Leg:.l Principles of Public Heulth administration Leigh, hk. D., Federal Henlth Administration Luckiesh & Pucini, Light und Health Mecoubs, C. E., City Health administration Moore, H. H., Public Health in the U. S. Newsholme, 4., Evolution of Preventive Medicine Newsholme, a., Story of Modern Preventive Medicine Overton & Denno, The Health Officer Park, WW. He, Public Health end Hygiene Phelps, &. B., Public Health Engineering Ravenel, M., Half Century of Public Health hice, T. b., Racial Hygiene hosensu, M. J., Preventive Medicine « Hygiene Sedgwick, Principles of Sanitary Scisnce Smiley & Gould, Community Hygione Steel & White, Hygiene of Community, School « Home Tobey, J. As, Public Heulth Law # U. S. Public Heelth Service, Bulletin No. 66, liilk « Its Relation to Public Health * White House Conference on Child Health & Protection (See full list in cztilog) EDUCATION (GENFRAL aNiL PHYSICaL) Brice, D. k., Measuring Motor ability * Curtis, H. S., Education Through Play Gurrett, Statistics in Psychology and lducation Gulick, L. &., A Philosophy of Play * Hetherington, C. W., Program in rhysical Education Lee, J., Play in Education McCall, wW. A., How to lieasure in Education sl os ale ae ite Nash, J. B., Mind and body Relationships Nash, J. I}., administration of Physical Education Payne « Schroeder, Health « Safety in the New Curricnuium Playground « Recreation association of america, The Normal Course in Play hogers, F. R., Physical Capacity Tests Ruch & Stoduard, Tests & hieasurements in High School Instruction kuch, G. M., The Objective or New Type Examination hugg, H. Q., Statistical Methods Applied to Education Williams, J. F., administration of Physical Education Williams, J. F., Principles of Physical Education Williams & Brambaugh, ifethods in Physical Education Williams & Hughes, Athletics in Education SOCIETAL HYGIENE — Syllabus _ tor gre euree 156 School of Hygiene and Physica] Education for Men a0 STANFORD UNIVERSITY | Ps : = | = 2 . 1930 LIST OF BOOKS FOR SOCIETAL HYGIENE American Public Health Assn. American Public Health Assn. Baker, J... Barker and Sprunt Bossard, J. W. Bramard, A.M. Broadhurst Dublin, L. I. Hiscock, Ira Kerr, James Leigh McCombs, C. E. McLaughlin Moores H. H. Moore, H. H. Newsholme Arthur (Sir) Overton and Demno Park, Wm. H. Phelps Ravenal, M, Research Division, American Child Health Association Rice Rosenau, M. Jd. Sedgwick U. S. Hygiene Bulletin #56 Whipple, G. C. Course 154 Appraisal Form for Rural Health Work Appraisal Form for City Health Work Child Hygiene ve The Degenerative Disease Problems of Social Well-being Organization of Public Heaith Nursing Home and Community Hygiene Health and Yealth Community Health Organization Fundamentals of School Health 371.7 K4l Federal H. Administration in U.S. City Health Administration Communicable Diseases American Medicine and the People's Health Public Health in the United States The Evolution of Preventive Medicine The Health Officer Public Health and Hygiene Principles of Sanitary Engineering 614.P539 A Half Century of Public Heaith Health Survey of 86 Cities, 1925 614.097a512 Conquest of Disease Preventive Me@icine and Hygiene (last ed.) Principles of Sanitary Science and Public Health Milk and Its Relation to Public Health Vital Statistics SOCIETAL HYGIENE - COURSE 154 I. OBJECTIVE The objective of this course is to prepare the individual for, and induce him to take an active intelligent part in, shaping the health policy and practices of his own community, state, and nation. II. PLAN meen In the brief time available for the course, our aim will be to: 1. Explore some of the sources and forms of our societal or community health practices. 2. Evaluate the soundness of these practices. 5. Estimate the adequacy of our present facilities for protecting the individual through the group. 4. Project the essentials of a public health program that promises the best results with our present knowledge of the principles of hygiene. ItI. DEFINITION OF THE FIELD For purposes of more accurate description, the field of hygiene has been classified under a number of distinct but inter-related divisions. These have been presented in former courses. Societal or intergroup hygiene is defined by Storey as "the application of the scientific facts of general hygiene in and by the public for the health wel- fare of the public." It is frequently called community or public hygiene. It conceives the public as being made up of associated groups of humans dominated by common health interests and exposed to comnon health dangers and competent to enforce standards of hygiene through the various units of government and by force of community custom. IV. BASIS OF SOCIETAL HYGIENE A brie# consideration of the bases of a societal or public hygiene program will be of value. 1. Economic Basis a. Values of reduced morbidity and mortality b. Values of increased efficiency ec. Values to communities. 2« Seientifie Basie a. Known causes and modes of transmission of disease. b. Known methods of cure and prevention of disease. c. Known methods of promotion of health. 5. Legal Basis a. Power to establish legal regulations b. Power to enforce regulations c. Power to appropriate money for health purposes. 2s Course 154 References: Bossard, J. W.--Problems of Social Well-being, Chaps. 7 & 16 Dublin, L. I.--Health and Wealth, Chapter 1 Moore, H. H.--Modern Medicine and the Public Health Goodnow--Constitutional Foundations of Public Health U.S.Public Health Service Reprint 559 (Document Rm.) V. SUBDIVISIONS OF SOCIETAL HYGIENE For purposes of discussion, societal hygiene may be considered under several subdivisions. 1. Educational hygiene. The necessity facts makes educational hygiene one department of health, and the whole é. Informational hygiene. Modern life researches, surveys, and studies of health. This service is a function laboratories; research divisions of organizations of experts. 5. Constructive hygiene. Includes the for wider diffusion of hygienic of the important functions of the educational system. demands a continuous process of new ways to protect and promote of departments of health; scientific colleges and universities; and intergroup provisions for securing and safeguarding the food supply; provision for play and recreation; and regulation of transportation of facilities. 4, Defensive hygiene. Community provision for defenses against health hazards involved in water supply, milk supply, waste disposal, communi- cable diseases, physical, mechanical, biological, and chemical causes of ill health. VI. PRESENT STATUS OF HEALTH SERVICE IN UNITED STATES A knowledge of what is now being done to meet the health service needs of our people is the first step in judging the adequacy of our public hygiene pro- gram. This can best be obtained by a brief review of the work of the official and voluntary agencies in the health field. Governmental Agencies. The health work of the government should be consider- ed under the head of federal, state, and local units. 1. Federal Health Agencies. The health work of the Federal government is not concentrated in a single department but is scattered through many bureaus. Only the most important will be considered. a. U.S. Public Health Service. The most important Federal agencies. Administered as a Bureau in the Treasury Department. Originated (1798) as Marine Hospital Service to care for sick and disabled seamen. Powers and functions have been gradually broadened: (1) Protection of U.S. from disease from without (2) Prevention of interstate spread of disease (3) Co-operation with State and local Boards of Health (4) Investigation of causes of human disease (5) Supervision of biological products (6) Public health education. Course 154 je Activities (1) Maritime quarantine - medical examination of immigrants. (2) Hygienic laboratory (3) Interstate quarantine (4) Public health reports and bulletins Children's Bureau (Dept. of Labor) - Next to the U.S.P, Health Ser- vice, is the most important federal health agency. Functions: (1) Investigation of causes of infant mortality and diseases of children (2) Administration of the Sheppard-Towner Maternity and Infancy Act. (3) Publications and educational activities. Bureau of Census (Dept. of Commerce) Collects, tabulates, and analyzes vital statistics. Bureau of Chemistry (Dept. of Agriculture) Administers the Pure. Food and Drug Act. Bureau of Education (Dept. of Interior) promotes school hygiene and health of Indians. Bureau of Labor Statistics (Dept. of Labor) makes industrial hygiene studies. Bureau of Animal Industry (Dept. of Agriculture). Supervises meat inspection and investigates animal diseases. Bureau of Entomology (Dept. of Agriculture) Insect studies affecting the health of man. Bureau of Biological Survey (Dept. of Agriculture). Eradication of rats and plague carrying ground squirrels. States Relations Service (Dept. of Agriculture) health education in rural communities. 2. Htate Health Departments. The state is the source of power to control health conditions. the state health department is a latér form of organ- ization than the local units. There is less scattering of health func- tions in the state health agencies. Qe b. Evolution of State Departments of Health (1) Boards with a Secretary and having principally advisory powers. Oregon as a type. (2) Commissioner with Advisory Council. Advisory functions and enlarged executive powers. New York and California as types. Advisory Functions (1) Investigation and research. (2) Advice to local boards of health Course 154 Ce d. (3) Laboratory service (4) Publicity and Exhibits Executive Functions (1) Communicable disease control (2) Nuisances affecting more than one sanitary district (3) Registration of Vital Statistics (4) Food and Drug control (5) Standards for water supply and sewage disposal (6) Control of factories and tenement houses (7) Distribution of vaccines and serums. Budgets. Range from 3 to 19¢ per capita. 5. Municipal Health Departments. The city health departments are the com~ pletest and most effective units in our public health service. In many of the larger cities, we now have complete programs. This is particularly true where partisan politics has been compelled to keep hands off and there is active co-operation of the educational system and the voluntary health and social agencies. . Be Ds Powers always derived from legislature through a charter. survey of Field (1) Report on Municipal Health Dept. Practice American P.H. Assn, (2) Survey of 86 Cities American Child Health Assn, Organization is dependent upon the form of municipal government. (1) Ex-officio boards. A single executive with some other body or board acting as a board of health. (2) appointive boards. Health officer and separate board. (3) Independent executive working under commission or city manaper. Divisional Organization, In a city with a complete program this usually consists of: )} Administration )} Communicable diseases ) Tuberculosis ) Venereal diseases ) Child hygiene ) Industriel hygiene ) Milk and food inspection ) Sanitation. (9) Laboratory service (10) Nursing (11)V4tal statistics (12) Hospitals =) (2 3 (4 (5 (6 (7 (8 Budgets. Range lig to $1.04 per capita. Average cities over 100,000- 51.69 per capita. Course 154 4, Rural Health Departments. The weakest link in our health chain. The reasons for this are the nature of our rural social and political organ- ization; the size of the allotmentto health; and the administrative difficulties. a. Survey of Field. Virtually all the rural health work now being done is the result of the co-operative efforts of local and state depart- ments of health with the U.S. Public Health Service and the Inter- national Health Board (Rockefeller Foundation) Only 19% in 1928 of rural population had local health service under the direction of a full time health officer. b. Rural Sanitation Service of U.S. Public Health Service. Created by Acts of 1893 and 1912, (1) Objectives (a) Improvement in sanitary devices (b) Co-operation with local health departments financially and functionally. (2) Methods (a) Small subsidies (b) Demonstrations (Cape Cod District) (3) Extent. 109 counties in 17 States. Such service needed for 60% of population. At present it is available for only 19%, (4) Cost (1928) Federal funds $77,628.01 State and local funds 948,838.24 Private organ- 91,489.53 izations Total $1,117,955.78 References: Public Health Reports - Nov. 30, 1928 (Document Room and Magazine Room) Contains excellent accounts of work of San Joaquin Health District, ¢. International Health Board is one of the subsidiaries of the Rockefeller Foundation. One of the important activities has been their co-operation with federal and local health officials in pro- moting rural public health. (1) Method. Through a co-operative agreement with State and Local government the I.H. Board gives financial support to local health projects until they have proven their worth and are taken over by the people. d. North Carolina County Health Work. Dr. Watson Rankin, State Health Of- ficer of North Carolina, has been one of the outstanding leaders in the rural health field. (Reference: North Carolina Health Bulletin, Jan. 1920) 7 . «“ 6 & Course 154 References: Leigh--Federal Health Administration in U.S. McCombs, C.h.--City Health Administration Moore, H. H.--Public Health in U.S. Newsholme~-The Evolution of Preventive Medicine Ravenal, M.-- A Half Century of Public Health - VII-2 VOLUNTARY OR PRIVATE HEALTH AGENCIES The evolution of the private health organizations has been one of the striking and vital factors in the development of health service in the United States. These agencies may be grouped under the head of: (1) Organizations; (2) Foundations; (3) Commercial agencies; (4) Industrial agencies. 1. Organizations. We have great numbers of organizations of private individuals who are interested in special problems. Time and space will permit only a mention of those having a national scope. a. National Tuberculosis Association (1904). A unique association with branches in all 48 states. (1) Activities, Field service on tuberculosis; surveys; research standards for hospitals; educational programs. {2) Support. Christmas seals. b. American Social Hygiene Association (1) Activities. Law enforcement; medical measures; educational activities; publications. (2) Support. Memberships and contributions from individuals and foundations. ec. National Committee for Mental Hygiene (1917) (1) Activities. Care of mentally diseased; clinics; teeching of papenrern ys surveys; prevention of delinquency d, American Society for Control of Cancer (1913) e. Association for Prevention of Heart Disease f. American Public Health Association g. National Organization of Public Health Nursing é. Foundations. Have increased in sizes, number, and scope of their acti- vities during the past 10 years. a. Rockefeller Foundation. Began activities as a sanitary commission to control hook worm (1909) -- was broadened in Foundation in 1918 with fund of 100 million dollars. Foundation consists of four divisions: International Health Board; China Medical Board; Division of Medical Education; Division of Studies, Course 154 International Health Board. This division is the health agency of the Foundation. Conducted on the policy that public health is © essentially a governmental function and therefore they work only through the official health agency. (1) Activities ; (Yellow Fever (a) Special campaigns (Hookworm (Malaria (b) County or rural health work (c) Health administration (d) Fellowships (e) Special projects: League of Nations (Health Section) b. Milbank Fund. A smaller foundation interested primarily in control of tuberculosis. Conducting intensive demonstrations in New York State. Also contributions to other health projects. ce. Commonwealth Fund. This fund is interested in child health demon- strations, mental hygiene, educational research, rural hospitals, educational research, and fellowships. 3. Commercial Agencies. This group of health agencies has undergone a rapid development during the past 25 years. ae Metropolitan Life Insurance Company ' (1) Educational (2) Nursing Service (3) Industrial (4) Statistical b. National Dairy Council. Local units and councils in all partsof United States. e. Food Companies (Postum Cereal, etc.) 4, Industrial Agencies. The growth of health programs in industry has been one of the remarkable developments in health service. These plans range from mere first aid stations to complete health programs, including medical and health service for both empbyees and families. Some of the outstanding examples may be mentioned: Ford Motor Co.; International Harvester Co.; &ndicott dihmpmShoe Co.; U.S. Steel Co.; Bell Telephone Co. References: Moore, H.H.--Public Health in United States, Chap. 11 O'Neil, D.C.--Medical Service for Industrial Workers, Journal Am- erican Medical Association, Nov. 17, 1928 -- p.1516. Kober and Hansen--Industriel Hygiene; Chap. 8 Reports of Rockefeller Foundation, Commonwealth Fund, (In general Library} Reports (annual) Surgeon General, U.S. Public Health Service (Document Room) VIII. ORGANIZATION AND POWERS OF HEALTH AGENCIES The legal principles underlying public health are based upon common law, statute law, and constitutional provisions. ee Course 154 The fundamental idea at the base of governmental action for the preservation of the public health is that of nuisance. The powers which have been gradually placed in the hands of health officials are based upon court decisions. These decisions have established the right of the government to regulate the conduct of its citizens in such a way that their acts or omissions do not materially or unreasonably injure other citizens. Sanitary powers are extraordinary and sweeping in character but must be justified and reasonable. (1) Arbitrary and summary power to deprive persons of liberty and property. (2) Check wholly or partly commercial operations. (3) Disturb civie life to any extent deemed necessary. 1. Sources of Power a. State. The sovereign power of the State as expressed through the legislature delegates sanitary functions to certain boards or individuals, The State reserves to itself any powers not delegated to local communities or to the Federal government. b. Local. Authority commonly vested in a local board of health or governing body. Frequently in cities through charter. ¢. Federal. Only such powers as have been granted by State to central government, 2. Application of Powers These powers are applied through: a. State Statutes establishing state and local boards of health and Special acts such as pure milk acts or laws for physical inspection of school children. b. Local Ordinances. These are made by local boards or council to make effective police powers to meet local condition. 5. Organization The organization of the varidus official health agencies are based upon statutes or charter provisions creating them. a. Board - method of appointment, composition, term. b. Personnel - powers of appointment, qualifications, tenure c. Finances - legal method of securing funds. d. Powers ~ extent and character of powers. References: Hemenway, H. B.--Legal Principles of Public Health Administration Goodnow--Constitutionel Foundations of Public Health (U.S. Public Health Reports, Oct. 3, 1919, or Reprint 559) Overton & Demno--The Health Officer, Chap, 1 Course 154 “« 2 @ IX. ESSENTIAL SERVICES IN A COMMUNITY HYGIENE PROGRAM The student may never have to control a water supply; do milk or food inspections; wrestle with waste disposal; or quarantine communicable diseases. It is believed that he should understand the hygienic principles involved and the method of their application as a basis for estimating the adequacy of the health protection in his ow community. "Life is the continuous adjustment of internal to external relations," Spencer. Air, water, and food are primary requisites of animal life and consti- tute three great channels of communication between life and its environment. 1. Water Supply ee a. Ownership of Supply (1) Public (2) Private b. Amount of Supply Based upon the requirements for physiologic uses of the individual and the amount needed for domestic and industrial purposes. (1) Individual. The average healthy man needs 1800 CC to 2100 CC in addition to the amount taken with food. (2) Domestic purposes, including cooking, bathing, dishwashing, Jaundry: 12-17 gals., a day per capita. (3) Per capita use. Abroad - 6-59 gallons U.S. - - From 53 in Fall River to 250 in Pittsburg. ¢. Sources of Supply The source from which a community secures its supply of water is of great hygienic importance. (1) Rain or snow water. Often used in rural areas. Secured from run-off of roofs and stored in cisterns. Soft-mawkish taste, Pure if properly protected. (2) Surface waters. Rivers, creeks, lakes, and impounding reservoirs. Frequently dangerous--always under suspicion. Should always be purified. (a) Rivers. The most common supply. Danger from drainage from inhabitants. (b) Lakes and ponds. Admireble supplies when kept free from human and industrial wastes, (c) Impounding reservoirs. Used for Storage and for purifi- cation. , (3) Ground waters. From wells and Springs. Apt to be hard, (a) Wells. Polluted most frequently from surface drainage, d. Protection of Supply. This is an economic as well as a’ health problem. » 30 Course 154 (1) Water-shed. Guarded from pollution by exclusion of campers, etc. (2) Sanitary Analysis. Should be regular and complete. (a) Physical properties (b) Microscopic (c) Chemical (d) Bacteriological (3) Purification. Under modern conditions this is almost always a necessary precaution, (a) Storage (b) Filtration (c) Chemical treatment 2. Milk Supply Milk is our most valuable and most dangerous food because: (1) Bacteria grow readily in milk (2) It is difficult to transport (3) It is readily decomposable (4) It is the only animal food we use raw. a. Control of Milk Supply Under modern conditions it is essential to control the production, sale, and distribution of milk in order to protect the public health. This is being accomplished by means of; (1) Legal control through State laws and local ordinances. (a) Milk standards are made an essential part of all milk regulations. They include: Physical standards Chemical standards Bacteriological standards Sanitary standards (b) Grading of milk is one of the best devices for the control of milk supply. {c) Pasteurization if properly carried out under super- vision is involuable. b. System of Control An adequate system of control for milk supply should include: (1) Good milk ordinance (2) Inspection of all raw milk supply (3) Chemical and bacteriological analysis (4) Supervision of milk plants (5) Publicity and education. 5. Food and Drug Supply The supervision of the food and drug supply of the community should be one of the important services of a health department. This should pro- tect the individual against adulteration of foods, as well as against the hazards of poisonous foods and infected food handlers. This involves the following activities; a 2% Course 154 ae Licensing annually all food handling establishments. b. Regulations governing quality and methods of handling foods. c. Inspection and scoring these establishments. ad, Food Handlers requirement for medical examination at regular intervals. 4. Waste Disposal The disposal of wastes such as garbage, ashes, and trash are more engineering than health problems. They should be conducted by the De- partment of Public Works, and only be supervised by the health depart- ment where they directly affect health. 5. Sewage Disposal This again is an engineering problem, but certain aspects of it should be under supervision of the health officer. The basic principles are to get rid of the sewage: (1) As rapidly as possible (2) With least damage to health and property (%) With least nuisance to fewest people (4) At smallest cost. From the health standpoint, the objective is to see to it that human excrement is removed from the community promptly and properly. Should assure complete reversion of organic matter to inorganic and mineral form. a. Systems of Disposal (1) Dry earth. Basis found in Mosaic Code. Rural areas and temporary camp. (2) Water carriage (a) Sewage (b) Combined: human and household wastes b. Methods of Disposal (1) Dilution up to capacity for proper oxidation (2) Treatment Fundamental Processes: (a) Separation of suspended matter (b) Destruction of putrescible organic matter (¢) Transformation of sludge to stable condition (d) Destruction or removal of bacteria Accomplished By: (a) Preparatory processes (b) Purification processes (c) Finishing processes (ad) Sludge disposal. References: McCombs--City Health Administration Phelps--Principles of Sanitary Engineering Rosenau--Preventive Medicine and Hygiene aS = Course 154 6. Control of Communicable Diseases Hisorically, control of communicable diseases was the first activity of the health department. a. Organization In the larger departments, there is usually a bureau or division in which ell of the work is centered, and in some cases a separate division for tuberculosis and venereal diseases. In smaller depart- ments the work is organized under control of health officer or someone having other duties as well as control of communicable dis- eases. (1) Field Force (a) Medical inspectors (b) Public health nurses (c) Quarantine officers b. Procedure (1) Legal. Action based upon State regulations and local ordinances. (2) Notification by card or phone. (3) Investigation of cases (fpidemiology) (4) Quarantine and isolation. (5) Campaigns against specific diseases (a) Tuberculosis (b) Venereal diseases (c) Typhoid (d) Diphtheria 7. Child Hygiene The modern conception of an adequate child hygiene program includes provision for pre-natsl, and obstetrical care, infant welfare, pre- school and school hygiene. By means of such a program we may hone to lessen stillbirth, increase the vitality of children born alive, safeguard them through the most dangerous periods of their lives, correct their disabling defects, and to pass the larger proportion of them on to the schools in good condition, and finally to graduete them from schools better able physically to carry on the business of living, a. Pre-natal Service The results reflected in our infant mortality rates indicate the need for adequate facilities for pre-natal care for all mothers, either by private physicians or clinics. b. Maternity Service The high maternal mortality in U.S. can only be reduced by improve- ment in quality and availability of good obstetrical service. Course 154 8. 9. a 8 es (1) Mid-wives (2) Nurses (3) Clinics (4) Hospitals c. Infant and Pre-school Service During this period, the individual must meet all the strains and struggles of successfully establishing himself as an individual. Technical service plus educational guidance are necessary for parents. (1) Child health stetions (2) Nursing service (3) Educational classes for parents. d. School Health Service At this period the child meets the dual responsibility of the public educational and public health authorities. The organization and administration of this service is often a subject of controversy. Which ever group is given the responsibility, there should be for the sake of the child, an active co-operation. (1) Control of environment (2) Control of communicable diseases (3) Physical examination and correction of defects (4) Health instruction and health training. “fe ?: Public Health Nursing Service Every modern community should have available for 100% of the population a well organized public health mrsing service. Whether this service is maintained by the official health department or by a private health organization will depend upon local conditions. (1) Obstetrical and bedside care (2) Infant and pre-school (3) School nursing (4) Specialized nursing. Statistical Service —— The registration tabulation and study of the vital statistics of a community is fundamental to an intelligent health program. Where the health official is also the Registrar of Vital Statistics, the problem is simplified. (1) Registration of births, deaths, and marriages (2) Morbidity registration (3) Studies and reports References; Baker--Child Hygiene Kerr--Fundamentals of School Health Hiscock, fra--Catmurity Health Organization McLaughlin--Communicable Diseases McCombs--City Health Administration Overton and Demrio--The Health Officer Whipple, G.C.--Vital Statistics. — = Course 154 X. BVALUATION OF HEALTH PROGRAMS Sy With the growth in the size and complexity of health programs, it has become increasingly important to have some definite standards of measurement of the health needs and evaluation of the health programs of communities. 1. Surveys 9 appraisal forms. The work of the Committee on Health Department Practice of the American Public Health Association. References: McCombs, C.E.--City Health Administration, Chaps. 8, 11, 12, 13 Rice, Thomas--The Conquest of Disease, Chaps. 24-27 McLaughlin, A.--Communicable Diseases, Chaps. 1-6 Overton and Denno--The Health Officer American P.H. Assn.--R,port of Committee on Municipal Health Practice, Public Health Bulletin #136 (Document Room) U.S.P.H.S, American P.H. Assn,--Appraisal Form for Rural Health Work Appraisal Form for City Health Work Hiscock, {re--Community Health Organization